| Bloom Primary Mo II, LLC | |
|
540 Maryville Centre Dr Ste 340 Saint Louis MO 63141-5831 | |
| (303) 993-1330 | |
| Not Available |
| Full Name | Bloom Primary Mo II, LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 540 Maryville Centre Dr Ste 340, Saint Louis, Missouri |
| Authorized Official Name and Position | Debra Kay Moon Wadelton (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7209231250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bloom Primary Mo II, LLC 12600 W Colfax Ave Ste 200 Lakewood CO 80215-3733 Ph: (303) 993-1330 | Bloom Primary Mo II, LLC 540 Maryville Centre Dr Ste 340 Saint Louis MO 63141-5831 Ph: (303) 993-1330 |
| NPI Number | 1417871013 |
|---|---|
| Provider Enumeration Date | 08/06/2026 |
| Last Update Date | 08/06/2026 |
| Certification Date | 08/06/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417871013 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
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